Piers Dawes

Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group 'white paper'.

Abstract Objective: There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity reflects both the relative immaturity of the field and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. Design: This discussion paper provides working definitions for listening effort and listening-related fatigue. Using these definitions as a framework, methodologies to assess these constructs are reviewed. Results: Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. Conclusion: We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue. Foreword Following recent interest in the cognitive involvement in hearing, the British Society of Audiology (BSA) established a Special Interest Group on Cognition in Hearing in May 2013. In an exploratory group meeting, the ambiguity surrounding listening effort and fatigue was discussed. To address this problem, the group decided to develop a ‘white paper’ on listening effort and fatigue. This is a discussion document followed by an international set of commentaries from leading researchers in the field. An approach was made to the editor of the International Journal of Audiology who agreed to this suggestion. This paper, and the associated commentaries that follow, are the result.

Hearing loss and cognition: the role of hearing AIDS, social isolation and depression.

Hearing loss is associated with poor cognitive performance and incident dementia and may contribute to cognitive decline. Treating hearing loss with hearing aids may ameliorate cognitive decline. The purpose of this study was to test whether use of hearing aids was associated with better cognitive performance, and if this relationship was mediated via social isolation and/or depression. Structural equation modelling of associations between hearing loss, cognitive performance, social isolation, depression and hearing aid use was carried out with a subsample of the UK Biobank data set (n = 164,770) of UK adults aged 40 to 69 years who completed a hearing test. Age, sex, general health and socioeconomic status were controlled for as potential confounders. Hearing aid use was associated with better cognition, independently of social isolation and depression. This finding was consistent with the hypothesis that hearing aids may improve cognitive performance, although if hearing aids do have a positive effect on cognition it is not likely to be via reduction of the adverse effects of hearing loss on social isolation or depression. We suggest that any positive effects of hearing aid use on cognition may be via improvement in audibility or associated increases in self-efficacy. Alternatively, positive associations between hearing aid use and cognition may be accounted for by more cognitively able people seeking and using hearing aids. Further research is required to determine the direction of association, if there is any direct causal relationship between hearing aid use and better cognition, and whether hearing aid use results in reduction in rates of cognitive decline measured longitudinally.

Profile and aetiology of children diagnosed with auditory processing disorder (APD)

OBJECTIVE Auditory processing disorder (APD) is characterised by listening difficulties despite a normal audiogram. APD is becoming ever more widely diagnosed in children, though there is a controversy over definition, diagnosis and aetiology. This study sought to describe presenting features and investigate aetiological factors for children diagnosed with APD compared to those for whom APD was excluded. METHODS Medical notes for children referred to a specialist hospital-based APD clinic were reviewed in relation to presenting features and potential aetiological factors. RESULTS 32 children diagnosed with APD and 57 non-APD children were compared. They reported similar symptoms and similarly had high rates of co-morbid learning problems. No aetiological factor (including history of otitis media, adverse obstetric history or familial history of listening problems) predicted APD group membership. CONCLUSIONS Children identified with APD on the basis of commonly used APD tests cannot be distinguished on the basis of presenting features or the aetiological factors examined here. One explanation is that learning problems exist independently of auditory processing difficulties and the aetiological factors do not have a strong causal role in APD. However, no gold standard for APD testing exists and an alternative explanation is that the commonly used APD tests used as selection criteria in this study may be unreliable.

Auditory processing disorder in relation to developmental disorders of language, communication and attention: a review and critique

BACKGROUND Auditory Processing Disorder (APD) does not feature in mainstream diagnostic classifications such as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), but is frequently diagnosed in the United States, Australia and New Zealand, and is becoming more frequently diagnosed in the United Kingdom. AIMS To familiarize readers with current controversies surrounding APD, with an emphasis on how APD might be conceptualized in relation to language and reading problems, attentional problems and autistic spectrum disorders. METHODS & PROCEDURES Different conceptual and diagnostic approaches adopted by audiologists and psychologists can lead to a confusing picture whereby the child who is regarded as having a specific learning disability by one group of experts may be given an APD diagnosis by another. While this could be indicative of co-morbidity, there are concerns that different professional groups are using different labels for the same symptoms. CONCLUSIONS & IMPLICATIONS APD, as currently diagnosed, is not a coherent category, but that rather than abandoning the construct, we need to develop improved methods for assessment and diagnosis, with a focus on interdisciplinary evaluation.

Relation between Speech-in-Noise Threshold, Hearing Loss and Cognition from 40–69 Years of Age

Background Healthy hearing depends on sensitive ears and adequate brain processing. Essential aspects of both hearing and cognition decline with advancing age, but it is largely unknown how one influences the other. The current standard measure of hearing, the pure-tone audiogram is not very cognitively demanding and does not predict well the most important yet challenging use of hearing, listening to speech in noisy environments. We analysed data from UK Biobank that asked 40–69 year olds about their hearing, and assessed their ability on tests of speech-in-noise hearing and cognition. Methods and Findings About half a million volunteers were recruited through NHS registers. Respondents completed ‘whole-body’ testing in purpose-designed, community-based test centres across the UK. Objective hearing (spoken digit recognition in noise) and cognitive (reasoning, memory, processing speed) data were analysed using logistic and multiple regression methods. Speech hearing in noise declined exponentially with age for both sexes from about 50 years, differing from previous audiogram data that showed a more linear decline from <40 years for men, and consistently less hearing loss for women. The decline in speech-in-noise hearing was especially dramatic among those with lower cognitive scores. Decreasing cognitive ability and increasing age were both independently associated with decreasing ability to hear speech-in-noise (0.70 and 0.89 dB, respectively) among the population studied. Men subjectively reported up to 60% higher rates of difficulty hearing than women. Workplace noise history associated with difficulty in both subjective hearing and objective speech hearing in noise. Leisure noise history was associated with subjective, but not with objective difficulty hearing. Conclusions Older people have declining cognitive processing ability associated with reduced ability to hear speech in noise, measured by recognition of recorded spoken digits. Subjective reports of hearing difficulty generally show a higher prevalence than objective measures, suggesting that current objective methods could be extended further.

Hearing in middle age: A population snapshot of 40- to 69-year olds in the united kingdom

Objectives: To report population-based prevalence of hearing impairment based on speech recognition in noise testing in a large and inclusive sample of U.K. adults aged 40 to 69 years. The present study is the first to report such data. Prevalence of tinnitus and use of hearing aids is also reported. Design: The research was conducted using the UK Biobank resource. The better-ear unaided speech reception threshold was measured adaptively using the Digit Triplet Test (n = 164,770). Self-report data on tinnitus, hearing aid use, noise exposure, as well as demographic variables were collected. Results: Overall, 10.7% of adults (95% confidence interval [CI] 10.5–10.9%) had significant hearing impairment. Prevalence of tinnitus was 16.9% (95%CI 16.6–17.1%) and hearing aid use was 2.0% (95%CI 1.9–2.1%). Odds of hearing impairment increased with age, with a history of work- and music-related noise exposure, for lower socioeconomic background and for ethnic minority backgrounds. Males were at no higher risk of hearing impairment than females. Conclusions: Around 1 in 10 adults aged 40 to 69 years have substantial hearing impairment. The reasons for excess risk of hearing impairment particularly for those from low socioeconomic and ethnic minority backgrounds require identification, as this represents a serious health inequality. The underuse of hearing aids has altered little since the 1980s, and is a major cause for concern.

Validity of a protocol for adult self-report of dyslexia and related difficulties

Background There is an increased prevalence of reading and related difficulties in children of dyslexic parents. In order to understand the causes of these difficulties, it is important to quantify the risk factors passed from parents to their offspring. Method 417 adults completed a protocol comprising a 15-item questionnaire rating reading and related skills and a scale assessing ADHD symptoms; 344 completed reading, nonword reading and spelling tests. Results A confirmatory factor analysis with four factors (Reading, Word Finding, Attention and Hyperactivity) provided a reasonable fit to the data. The Reading Factor showed robust correlations with measured literacy skills. Adults who reported as dyslexic, or rated their reading difficulties as more severe, gained lower scores on objective measures of literacy skills. Although the sensitivity of the new scale was acceptable, it tended to miss some cases of low literacy. Conclusions Self-report scales of reading and of attention difficulties are useful for identifying adults with reading and attention difficulties which may confer risks on their children of related problems. It is important for research following children at family risk of dyslexia to be aware of these effects. Copyright

Temporal auditory and visual motion processing of children diagnosed with auditory processing disorder and dyslexia.

Objective: Auditory processing disorder (APD) is diagnosed on the basis of listening difficulties despite normal audiogram, although the cause is unknown. This study examined the hypothesis that the underlying cause of APD is a modality-specific deficit in auditory temporal processing and also considered how far the auditory impairments in APD differ from those in children with dyslexia. Design: Performance of children diagnosed with APD (N = 22) was compared with that of a normative group (N = 98) as well as with children with dyslexia (N = 19) on a battery of temporal auditory tasks; 2-Hz frequency modulation (FM), 40-Hz FM, and iterated rippled noise detection as well as a control task (240-Hz FM), which is thought to draw on peripheral spectral mechanisms. Visual tasks were coherent form and coherent motion detection. Results: On average, the APD group performed more poorly than the normative group on the 40-Hz FM, 240-Hz FM, and iterated rippled noise tasks. There were no significant differences between the APD and dyslexia groups performance and no evidence for a specific temporal auditory impairment. A higher proportion of children in the APD group performed poorly (<−1 SD) on the visual tasks than those in the normative group. Auditory psychophysical performance correlated positively with the performance on the SCAN-C, a standardized test of auditory processing, but not with reading ability. Conclusions: The research did not support a modality-specific impairment of temporal auditory processing as being the underlying cause of APD. In both the APD and dyslexia groups, a similar proportion displayed poor auditory performance, and this does not seem entirely accounted for by attention or performance I.Q. However, the significance of these auditory difficulties is uncertain. Serious difficulties with auditory assessment were also identified. Currently, auditory perceptual deficits may be better seen as a part of a multifactorial description of learning problems rather than as part of a diagnostic category in their own right.

The SCAN-C in testing for auditory processing disorder in a sample of British children

Abstract Objective: The SCAN-A (12) is a test for auditory processing disorders in adolescents aged 11+ and adults developed in the USA. It was previously found that the childrens version (the SCAN-C) over diagnoses auditory processing disorder in UK children. This study was conducted to assess the use of the SCAN-A with UK adults. Design: Comparison of UK adults SCAN-A performance to US-based normative data. Study Sample: 31 UK adults aged 19 to 64 years (M 24, sd 10). Results: The UK sample scored significantly worse on three subtests: the Filtered Words (FW), Competing Words (CW) and Competing Sentences (CS) sections as well as on the Total Score. Conclusions: Applying US norms to UK adults performance results in a high rate of over-identification of listening difficulties. Alternative UK norms are provided and implications for use of the SCAN-A with UK adolescents and adults are discussed. Sumario Objetivo: El SCAN-A (12) es una prueba para trastornos de procesamiento auditivo en adolescentes de más de 11 años y en adultos, desarrollada en los EEUU. Se encontró previamente que la versión para niños (SCAN-C) sobre-diagnostica trastornos de procesamiento auditivo en niños del Reino Unido. Este estudio fue conducido para evaluar el uso del SCAN-A en adultos del Reino Unido. Diseño: Comparación del desempeño con el SCAN-A de adultos del Reino Unido con los datos normativos de los EEUU. Muestra Del Estudio: Treinta y uno adultos del Reino Unido con edades entre los 19 y los 64 años (M 24, sd 10). Resultados: La muestra del Reino Unido obtuvo un resultado significativamente peor en tres sub-pruebas: las secciones de Palabras Filtradas (FW), de Palabras en Competencia (CW) y de Frases en Competencia (CS), así como en el puntaje total. Conclusiones: La aplicación de normas de los EEUU al desempeño de adultos del Reino Unido resulta en una alta tasa de sobre-identificación de trastornos de audición. Se proporcionan normas alternativas para el Reino Unido y se discuten las implicaciones para el uso del SCAN-A en adolescentes y adultos del Reino Unido.

Psychometric profile of children with auditory processing disorder and children with dyslexia

Objective The aim was to address the controversy that exists over the extent to which auditory processing disorder (APD) is a separate diagnostic category with a distinctive psychometric profile, rather than a reflection of a more general learning disability. Methods Children with an APD diagnosis (N=25) were compared with children with dyslexia (N=19) on a battery of standardised auditory processing, language, literacy and non-verbal intelligence quotient measures as well as parental report measures of communicative skill and listening behaviour. A follow-up of a subset of children included a parent report screening questionnaire for Asperger syndrome (Childhood Asperger Syndrome Test). Results There were similarly high levels of attentional, reading and language problems in both groups. One peculiarity of the APD group was a discrepancy between parental report of poor communication and listening skill disproportionate to expectations based on standardised test performance. Follow-up assessment suggested high levels of previously unrecognised autistic features within the APD group. Conclusions Children diagnosed by audiological experts as having APD are likely to have broader neurodevelopmental disorders and would benefit from evaluation by a multidisciplinary team.